Pseudotumour cerebri in children: Aetiology, clinical features, and progression. / Seudotumor cerebri en niños: etiología, características clínicas y evolución.

INTRODUCTION: The definition, associated aetiologies, diagnosis, and treatment of idiopathic intracranial hypertension, or pseudotumour cerebri (PTC), are constantly being revised in the paediatric population. OBJECTIVES AND METHODS: Our study included children younger than 15 years old with PTC and attended at a reference hospital in the past 12 years. We analysed the clinical and epidemiological features of our sample and the diagnostic and treatment approaches. PTC was defined as presence of intracranial hypertension (CSF opening pressure>25cmH2O) and absence of space-occupying lesions in brain MR images. RESULTS: A total of 12 children with PTC were included; mean age was 10 years and 90% were girls. Weight was normal in all patients. Eighty-two percent of the patients had symptoms: headache (66%), diplopia (8%), and visual loss (8%). All of them displayed papilloedema (17% unilaterally). Lumbar puncture (LP) provided the diagnosis in all cases and 91% showed no relevant MRI findings. A potential cause of PTC was identified in 5 cases: pharmacological treatment in 2 and infection (Mycoplasma pneumoniae [M. pneumoniae]) in 3. Ninety-one per cent of the patients received treatment: 75% underwent several LPs and 42% received acetazolamide and/or prednisone. Outcomes were favourable in all cases. CONCLUSIONS: The incidence of PTC was estimated at approximately 1 case per 100 000 children/years, in line with data reported by previous studies. Overweight was not found to be a risk factor for PTC in this population. M. pneumoniae infection may trigger PTC and cause recurrences at later stages. The absence of symptoms seems to be independent from the degree of intracranial hypertension. Acetazolamide treatment is effective in most cases, and it represents a viable alternative to repeated LP.

[A comparative study of three systems for quantifying the spike and wave index in patients with continuous spikes and waves during slow sleep]. / Estudio comparativo entre tres sistemas de cuantificacion del indice de punta-onda en pacientes con punta-onda continua del sueño lento.

INTRODUCTION: Continuous spikes and waves during slow sleep (CSWS) is an epileptic encephalopathy of childhood with a pattern of epileptiform discharges during sleep, which, if prolonged over time, produce severe neuropsychological impairment. Quantification of the paroxysms by means of a spike and wave index (SWI) > 85% establishes a presumptive diagnosis and allows early therapy to be started to prevent such impairment. AIMS: To compare the results of the classic method for calculating the SWI against two proposals that optimise the relation between the analysis time employed and the diagnostic sensitivity. PATIENTS AND METHODS: The nocturnal electroencephalographic registers of 17 patients with CSWS were studied. Two observers calculated the SWI with the classic method, as well as with two other methods, M2 and M3, first in the active phase and then in the remission phase. The time required by each method, the individual SWI values and the agreement between methods and observers were compared. RESULTS: With M3 two of the patients failed to reach the cut-off point of SWI > 85%. Agreement in the active phase of CSWS after M2 and M3 was 0.762 and 0.704, respectively, while in the remission phase it was 0.951 and 0.830. Inter-observer agreement exceeded 0.905 in all cases. CONCLUSIONS: The two abbreviated methods can be used in both the active and the remission phases, with a substantial reduction in the analysis time that is needed. Our results support the current tendency to consider SWI > 60% as suggestive of CSWS. Method M2 yields results that are closer to those of the classic method than those of M3.

TITLE: Estudio comparativo entre tres sistemas de cuantificacion del indice de punta-onda en pacientes con punta-onda continua del sueño lento.Introduccion. La punta-onda continua del sueño lento (POCS) es una encefalopatia epileptiforme infantil con un patron de descargas epileptiformes durante el sueño que, prolongadas en el tiempo, producen un grave deterioro neuropsicologico. La cuantificacion de los paroxismos mediante el indice de punta-onda (SWI) > 85% establece un diagnostico de sospecha y permite iniciar una terapia precoz que puede evitar dicho deterioro. Objetivos. Comparar los resultados del metodo clasico de calculo del SWI con dos propuestas que optimicen la relacion entre el tiempo de analisis empleado y la sensibilidad diagnostica. Pacientes y metodos. Se estudiaron los registros electroencefalograficos nocturnos de 17 pacientes con POCS. Dos observadores calcularon el SWI con el metodo clasico, asi como con otros dos metodos, M2 y M3, primero en la fase activa y posteriormente en la fase de remision de la POCS. Se comparo el tiempo consumido por cada metodo, los valores individuales de SWI y la concordancia entre metodos y observadores. Resultados. Con el M3 dos pacientes no alcanzaron el corte del SWI > 85%. La concordancia en la fase activa de la POCS tras el M2 y el M3 fue de 0,762 y 0,704, respectivamente, mientras que en la fase de remision fue de 0,951 y 0,830. La concordancia entre observadores supero el 0,905 en todos los casos. Conclusiones. Los dos metodos abreviados se pueden utilizar tanto en la fase activa de la POCS como en la fase de remision, con una sustancial reduccion del tiempo de analisis empleado. Nuestros resultados apoyan la tendencia actual de considerar el SWI > 60% como sugestivo de POCS. El metodo M2 arroja resultados mas cercanos a los del metodo clasico que los de M3.

[Dietary patterns in patients with attention deficit hyperactivity disorder]. / Modelo dietético en pacientes con déficit de atención e hiperactividad.

OBJECTIVE: To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER). MATERIAL AND METHODS: A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150 healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. RESULTS: The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < .05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < .05) in the control group. Calorie intake at supper was significantly higher (P < .05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group. CONCLUSIONS: Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families.

Magnetic resonance imaging abnormalities in children with epilepsy.

BACKGROUND AND PURPOSE: The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. METHODS: Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. RESULTS: The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). CONCLUSIONS: The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.

[Nutrition and attention deficit hyperactivity disorder: developmental follow-up of the anthropometric variables of a group of patients receiving treatment with osmotic controlled-release methylphenidate]. / Nutricion y trastorno por deficit de atencion/hiperactividad: seguimiento evolutivo de las variables antropometricas de un grupo de pacientes en tratamiento con metilfenidato de liberacion osmotica.

AIM: To perform a developmental analysis of the anthropometric variables of a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) in order to determine the repercussions of treatment with osmotic controlled-release methylphenidate (MTF-OROS). PATIENTS AND METHODS: The medical records of 187 patients with ADHD under treatment with MTF-OROS over a period of 30 months were reviewed. Data collected included weight, height and body mass index at diagnosis (baseline) and at 6, 12, 18, 24 and 30 months' follow-up. RESULTS: The mean age at diagnosis was 8.14 ± 1.6 years. The dose of MTF-OROS was progressively increased until 36.9 ± 12.1 mg/day (1.05 mg/kg/day) at day 30 of the follow-up. At diagnosis, 34.9% of patients had a deficient nutritional situation (subnutrition or malnutrition), which affected 50.3% of the patients at 30 months. The baseline value for weight (Z-score) progressively decreased during treatment until values that were significantly lower than the baseline value at 12 months were reached (p < 0.05); these values remained significantly lower until 30 months. The baseline value for height (Z-score) also progressively decreased during treatment until values that were significantly lower than the baseline value at 24 and 30 months were reached (p < 0.05). CONCLUSIONS: At the time they were diagnosed with ADHD, one out of every three patients was in a deficient nutritional situation (subnutrition or malnutrition). Continued treatment with MTF-OROS for 30 months had a negative influence on height, which could perhaps be attenuated by improving the patients' nutrition.

Infantile convulsions with mild gastroenteritis: a retrospective study of 25 patients.

BACKGROUND: The aim of this study was to analyze the epidemiologic, clinical, and evolutional characteristics in patients who presented convulsions with mild gastroenteritis (CwG) to facilitate the diagnosis in daily clinical practice. METHODS: Twenty-five medical records of patients diagnosed with CwG were reviewed, and the epidemiological and clinical features, results of complementary studies, and evolutional data were collected. RESULTS: Age of onset ranged between 12 and 24 months in 76% of patients. Female/male ratio was 2.6 (18 women and seven men). Seizures were mostly brief (<5 min) and apparently generalized, and often repetitive occurring in cluster (2.2 seizures per episode). One patient with status epilepticus was recorded. The average interval between the onset of gastroenteritis and seizures was 3.8 days, even though seizure preceded diarrhea in three cases. Mean rectal temperature at the moment of seizure was 37.1°C. Rotavirus antigen was positive in stool in 17 episodes (55.8%). There were no abnormalities in serum biochemistry tests and cerebrospinal fluid studies. Four patients showed anomalies in the interictal electroencephalogram. The period of follow-up was 4.2 years. Five patients (20%) experienced recurrences when suffering a new gastroenteritis episode. One patient developed epilepsy during the follow-up period. CONCLUSIONS: CwG would constitute a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of patients relapse when suffering a new diarrhea episode.

[Epilepsy and epileptic syndromes during the first year of life]. / Epilepsias y síndromes epilépticos durante el primer año de vida.

AIM: To analyse the epidemiological characteristics and the relative distribution of the different types of epilepsy and epileptic syndromes during the first year of life. PATIENTS AND METHODS: An analysis was performed of the patient records of all patients with epilepsy diagnosed during their first year of life who were submitted to a developmental check-up in the year 2007. The sample consisted of 60 patients (27 boys and 33 girls). Epidemiological and clinical data were collected, together with the findings from complementary examinations. The diagnostic criteria applied were those of the International League Against Epilepsy. RESULTS: The mean age at the time of diagnosis was 6.3 months. The mean follow-up time was 7.6 years. The aetiology was symptomatic in 40 cases (66.7%), cryptogenic in 16 (26.7%) and idiopathic in four cases (6.7%). Neuroimaging tests detected abnormalities in 34 patients (56.7%). West's syndrome (30%), symptomatic focal epilepsies (23.3%) and epilepsies linked to specific syndromes (16.7%) were the epileptic syndromes with the highest prevalence. Learning disabilities were observed in 82.5% of the children. CONCLUSIONS: Most epilepsies that present during the first year of life are symptomatic and/or cryptogenic, and are accompanied by psychoneurological impairment and/or resistance to therapy, which condition cognitive disorders that are eligible for specialised psycho-pedagogical intervention.

[Rolandic epilepsy: epidemiological and clinical characteristics and outcome]. / Epilepsia rolándica: características epidemiológicas, clínicas y evolutivas.

OBJECTIVE: To analyse the epidemiological, clinical and developmental characteristics of Rolandic epilepsy as an aid to its suspected diagnosis in daily clinical practice. PATIENTS AND METHODS: The medical records of 56 patients with Rolandic epilepsy were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The criteria defined by the International League Against Epilepsy (ILAE) were used in the diagnosis. RESULTS: Mean age at diagnosis was 7.7 years. In all, 62.5 % were diagnosed at school age, with a higher prevalence of males (58.9 %). Seizures occurred during sleep in 84.4 % of patients, and they were mainly characterised by hemifacial seizures with eye deviation and/or headaches (76.8 %), hypersalivation (44.6 %), guttural sounds (30.6 %), secondary generalised tonic-clonic (35.7 %) and/or unilateral clonic or tonic seizures (26.8 %), dysarthria (17.9 %) and unilateral paresthesias (16.1 %). Inter-ictal EEG showed paroxysms in the centrotemporal regions, frequently unilateral (78.6 %). Of all recurrences, 50.7 % occurred during the first 12 months after diagnosis, 24.6 % between 12 and 24 months after diagnosis, and 24.6 % between 2 and 4 years of follow up. Two patients with atypical progression were recorded: a case with epilepsy with continuous spikes and waves during slow-wave sleep, and another case with a Landau-Kleffner syndrome. CONCLUSIONS: Rolandic epilepsy is a common type of epilepsy in the pediatric age group and generally begins at school-aged children. Its semiological sequence is fairly characteristic, and finding centrotemporal spikes is considered as necessary for the syndromic diagnosis. The prognosis is excellent; however, as a few patients may progress to atypical outcomes and/or neuropsychological deficits, a rigorous developmental control of these patients should be of the highest priority.

[Reversible posterior leukoencephalopathy: report of two cases after vincristine treatment]. / Leucoencefalopatía posterior reversible: descripción de dos casos asociados a vincristina.

Reversible posterior leukoencephalopathy syndrome is a clinical-radiological phenomenon associated with headache, vomiting, lethargy, visual disturbances and seizures, concomitant with radiological abnormalities predominantly within posterior cerebral white matter due to cerebral edema. There are multiple triggers as acute hypertension, cancer, hematological disease, renal pathology, red cells transfusions and different drugs. We present two patients with reversible posterior leukoencephalopathy under treatment for acute lymphoblastic leukemia because of the probable association with vinca alkaloids.

Panayiotopoulos syndrome: epidemiological and clinical characteristics and outcome.

The aim of this study was to analyse the epidemiological, clinical and evolutional characteristics of Panayiotopoulos syndrome (PS) in order to facilitate the diagnosis in daily clinical practice. Thirty-seven medical records of patients diagnosed with PS were reviewed and the epidemiological and clinical features, results of complementary studies and evolutional data were collected. Mean age at diagnosis was 5.4 years. Female/male ratio was 2.1. The majority of seizures occurred during sleep (67.2%). They usually begin with autonomic manifestations or vomiting (70.1%). Ictal eye and/or cephalic deviation and progression to partial or generalized convulsions were also quite frequent. EEG showed occipital spikes in 28 patients (75.7%). Besides, 71.3% of recurrences were observed in the first 6 months after diagnosis, and 82.9% of the patients had no seizures beyond 2 years from diagnosis. One patient with an atypical development was recorded. The PS is a relatively frequent epileptic syndrome in paediatric age, especially in pre-school children. Although its semiological sequence is fairly typical, the unspecific clinical and neurological characteristics complicate the diagnostic suspicion. Prognosis is excellent; however, it would be convenient to keep a strict evolutional follow-up in these patients as an atypical evolution might occur.

[Incidence of epilepsy in 0-15 year-olds]. / Incidencia de la epilepsia infantil.

OBJECTIVE: To calculate the annual incidence rate of epilepsy, as well as the relative distribution of the different forms of epilepsy and epileptic syndromes in infants and children. PATIENTS AND METHODS: All incident cases in infants and children aged less than 15 years living in Navarre (Spain) with newly diagnosed epilepsy (2002 to 2005) were prospectively registered. Epidemiological and clinical data and the results of complementary investigations were recorded. The criteria for epileptic seizures and epileptic syndromes of the International League Against Epilepsy (ILAE) and the ILAE guidelines for epidemiological studies were applied. RESULTS: One hundred ninety-nine patients were diagnosed with childhood epilepsy (22 infants, 66 young children, 54 school children and 49 adolescents). The annual incidence rate was 62.6 cases per 100,000 (95 % CI: 62.3-62.9). The incidence rate was highest during the first year of life (95.3 per 100,000) and gradually decreased until adolescence (48.7/100,000). Focal epilepsy was found in 55 %, generalized epilepsy in 42.9 %, and undetermined epilepsy in 2.1 %. In infants, the most prevalent epileptic syndromes were West syndrome (45.5 %), epilepsies associated with specific syndromes (27.5 %), and focal symptomatic epileptic syndromes (13.6 %). In early childhood, the main syndromes were focal symptomatic epilepsy (22.7 %), cryptogenic epilepsy (21.2 %), and Doose syndrome (13.6 %). In schoolchildren, the most frequent syndromes were focal benign epilepsies (27.8 %), cryptogenic epilepsy (18.5 %), and absence epilepsy (18.5 %). In adolescents, the most frequent syndromes were focal cryptogenic epilepsies (27.6 %) and benign epilepsies (18.4 %). CONCLUSIONS: The annual incidence rate of epilepsy in infants and children in Navarre is similar the rates described for other western countries, with the highest incidence rate being found during the first year of life and gradually diminishing until adolescence. Published data concerning the relative frequency of epilepsy and epileptic syndromes are discordant. These discrepancies highlight the difficulty of establishing a syndromic diagnosis in this age group and the need to apply uniform criteria in order to obtain valid and comparable epidemiological data.

[An epidemiological, clinical and developmental study of 37 patients with early-onset benign occipital epilepsy of childhood]. / Estudio epidemiológico, clínico y evolutivo de 37 pacientes con epilepsia occipital benigna infantil de comienzo precoz.

AIM: To analyse the epidemiological, clinical and developmental characteristics of early-onset benign occipital epilepsy of childhood in order to facilitate its diagnostic suspicion in daily clinical practice. PATIENTS AND METHODS: The medical records of 37 patients with early-onset benign occipital epilepsy of childhood were reviewed in order to collect epidemiological and clinical features, results of complementary examinations and developmental data. The diagnostic criteria applied were those of the ILAE (International League Against Epilepsy). RESULTS: The mean age at diagnosis was 5.4 years. In all, 64.9% were diagnosed at a pre-school age, with a greater prevalence of females (67.6%). The mean number of seizures per patient was 3.3 and they were mainly characterised by impaired consciousness (90.3%), vomiting (70.1%), eye deviation and/or headaches (30.6%), and generalised (32.8%) or partial (11.2%) motor crises. Seizures occurred during sleep in 67.2% of cases. In 28 cases (75.7%) occipital paroxysms were observed that coexisted with generalised and/or multifocal paroxysms. Of all recurrences, 71.3% occurred during the first 6 months, and from 2 years onwards 82.9% of the patients had no seizures; no developmental differences were found between treated and non-treated patients. One patient with an atypical development was recorded. CONCLUSIONS: Early-onset benign occipital epilepsy of childhood is relatively frequent at the paediatric age, especially in the pre-school years. Although its semiological sequence is quite characteristic, the fact that it lacks clinical and neurological specificity makes diagnostic suspicion more difficult. Its prognosis is especially favourable; however, since their progress may develop in an atypical manner, a rigorous developmental control of these patients would be of the highest priority.

[A descriptive study of childhood epilepsy]. / Estudio descriptivo de la epilepsia infantil.

AIM: To analyse the epidemiological characteristics and the relative distribution of the different types of epilepsy and epileptic syndromes in the childhood population. PATIENTS AND METHODS: We reviewed the medical histories of 365 patients (192 males and 173 females) with epilepsy. Epidemiological and clinical data were collected, together with information from complementary examinations. The diagnostic criteria applied were those of the International League Against Epilepsy (ILAE). RESULTS: The mean age at diagnosis was 5.9 years and the mean follow-up time was 4.6 years. A personal and/or familial history of febrile convulsions was reported in 13.4% of cases and 23.5% had a history of epilepsy in the family. The aetiology was idiopathic in 166 cases (45.5%), cryptogenic in 106 (29%) and symptomatic in 93 (25.5%). Of the total number of patients, 52.9% reported having focal epilepsies, they were generalised in 43.6% and 3.5% had epilepsies with an undetermined localisation. In each age group the most common epileptic syndromes were: in infants, West's syndrome (34.1%) and symptomatic focal epilepsies (24.4%); in preschoolers, idiopathic focal (21.3%) or cryptogenic (17.7%) and myoclonic-astatic epilepsies (12.8%); in school-age children, idiopathic focal epilepsies (27.3%) and absences (24.5%); and in teenagers, cryptogenic (26.6%) and idiopathic focal epilepsies (23.4%). CONCLUSIONS: The initial distinction between epileptic syndromes is usually difficult to establish and developmental monitoring is essential for reaching a definitive diagnosis and a classification of their syndromes. Age appears to be a determining factor in the clinical expression of the different types of childhood epilepsy, and the relative distribution of the epileptic syndromes is different in each age group.

[Epilepsy and epileptic syndromes among primary school children (6-12 years)]. / Epilepsias y síndromes epilépticos entre los alumnos de Educación Primaria (6-12 años).

OBJECTIVE: To analyze the epidemiological characteristics and proportional distribution of epilepsy and epileptic syndromes among primary school children. PATIENTS AND METHODS: The medical records of all children diagnosed with epilepsy between the ages of 6 and 12 years who attended a follow-up visit in 2005 were retrospectively reviewed. The sample consisted of 169 patients (85 boys and 84 girls). Epidemiological and clinical characteristics and complementary investigations were collected. The criteria defined by the International League Against Epilepsy (ILAE) were used in the diagnosis. RESULTS: The mean age at diagnosis was 8.8 years (95% CI: 0.2). The mean duration of follow-up was 3.5 years (95% CI: 0.32). Etiology was idiopathic in 102 patients (60.4%), cryptogenic in 36 (21.3%), and symptomatic in 31 (18.3%). A personal and/or familial history of febrile seizures was reported in 10.7% and familial epilepsy was found in 23.5%. Neuroimaging was performed in 162 patients (95.9%), and anomalies were detected in 33 (20.4%). In idiopathic epilepsies, generalized epilepsies were observed in 56.9% of the patients and focal seizure in 43.1%. Focal seizures were more frequent than generalized epilepsy in cryptogenic (63.9% versus 27.8%) and symptomatic forms (74.2 % versus 22.6%). The most prevalent syndromes were benign focal seizures (26.1%) and typical absence seizures (20.7%). Children with symptomatic epilepsies had a greater prevalence (p<0.05) of learning difficulties (66.7%) than those with cryptogenic (32.4%) or idiopathic forms (2.9%). CONCLUSIONS: Most seizures in primary school children were idiopathic (benign focal seizures and/or typical absence seizures) and did not interfere with schooling. Cryptogenic and symptomatic epilepsies were less prevalent, but a high proportion of patients had substantial neurological and mental impairment or was refractory to antiepileptic drugs, giving rise to educational and psychological needs requiring specialized intervention.

[Typical absence seizure: epidemiological and clinical characteristics and outcome]. / Ausencias típicas: características epidemiológicas, clínicas y evolutivas.

OBJECTIVE: To analyze the epidemiological and clinical characteristics and outcome of absence epilepsy in the pediatric age group with the aim of facilitating its diagnosis in clinical practice. PATIENTS AND METHODS: Information on epidemiological and clinical characteristics, complementary investigations, and outcome was collected from the medical records of 51 children with absence epilepsy. The criteria defined by the International League Against Epilepsy (ILAE) were used in the diagnosis. RESULTS: Fifty-one percent of the patients had simple absence seizures and 49% had complex absence seizures. A total of 70.6% of the patients were school-aged children and the prevalence was greater among girls (72.5%). The mean age at onset was 7.5 +/- 2.7 years. In 80%, there were multiple seizures per day with a mean duration of 12 seconds. School performance was impaired in 19.6%. Ictal electroencephalogram showed generalized 3 Hz spike and slow wave complexes in 84.3%. Hyperventilation was positive in 98%, and intermittent photic stimulation was positive in 15.7%. The seizures were controlled by sodium valproate (mean dosage: 26 mg/kg/day) in 84.3% of the patients. In 43 patients antiepileptic drugs were withdrawn (mean duration: 3.3 +/- 0.6 years) but 3 patients relapsed. CONCLUSIONS: Typical absences are a common type of epilepsy in the pediatric age group and generally begin in school-aged children. Absences may be difficult to detect and can impair learning. Treatment response is excellent. Nevertheless, because absences may be the first manifestation of severe forms of epilepsy syndromes, strict follow-up of these patients is essential.

[Acute recurrent headaches: clinical and epidemiological characteristics]. / Cefaleas agudas recurrentes: características clínicas y epidemiológicas.

OBJECTIVE: To analyze the epidemiological and clinical characteristics of migraine and tension-type headache in the pediatric age group with the aim of facilitating their differential diagnosis in clinical practice. PATIENTS AND METHODS: Information on epidemiological and clinical characteristics, physical examination and complementary examinations, if performed, was collected from the medical records of 225 children with acute recurrent headache. The criteria defined by the International Headache Society (IHS) were used in the diagnosis. RESULTS: A total of 98.2 % of the patients had primary headache: migraine (48.9 %), tension-type headache (48.4 %) and mixed (0.9 %). Thirty percent of those with migraine had migraine with aura. The mean age at onset was 8.6 6 2.9 years in migraine and 9.7 6 2.5 years in tension-type headache (p < 0.05), with no differences between sexes. Children with tension-type headache showed a greater prevalence (p < 0.05) of female sex, urban origin and excellent academic performance. Children with migraine had a greater prevalence (p < 0.05) of positive family history. Migraine headaches were unilateral (44.1 %) or bilateral (55.9 %), pulsating (77.1 %), aggravated by physical activity (68.8 %), caused lost days at school (65.3 %) and were usually accompanied by vomiting (71 %) and photophobia/sonophobia (67 %). Tension-type headaches were bilateral (81.8 %) and oppressive (85.3 %), were less frequently aggravated by physical activity (11.8 %) or interrupted activities (11.8 %) and were occasionally accompanied by vomiting (7.3 %) and photophobia/sonophobia (21.8 %). Electroencephalogram and brain computed tomography scan were performed in 21 % and 39.1 % of the patients, respectively, without changing their diagnosis. CONCLUSIONS: Migraine and tension-type headaches are a common cause of recurrent headache in the pediatric age group. Onset usually occurs in school-aged children. The IHS criteria for the differential diagnosis of headache in children are useful, although follow-up is the gold standard to validate diagnostic criteria.

[A long-term follow-up of 234 children with febrile seizures]. / Seguimiento a largo plazo de 234 niños con convulsiones febriles.

INTRODUCTION: Febrile seizures (FS) are a benign process, yet diverse factors have been identified as being related to a higher risk of relapses and epilepsy. AIMS: The purpose of this study was to perform a developmental analysis of a group of children with FS in order to determine the epidemiological and clinical factors that might condition the prognosis of these patients. PATIENTS AND METHODS: We reviewed the records of 234 children who had had their first seizure between 1989 and 1996; epidemiological, clinical and developmental data were collected. Patients at neurological risk were excluded. Patients were divided into two groups according to whether they had their first FS before (smaller group, n = 69) or after (larger group, n = 165) reaching the age of 15 months. RESULTS: The mean age at the first FS was 20.6 +/- 8.9 months, being higher (p < 0.05) in children with a single FS (23.6 +/- 9.1 months) and lower (p < 0.05) in those who had relapses (17.7 +/- 7.4 months) and epilepsy (14.3 +/- 6.5 months). The male/female ratio was 1.09 in the smaller group and 1.96 in the larger group (p < 0.05). The risk of relapses was 73.9% in the smaller group and 33.1% in the larger group (p < 0.05), and in both groups it increased if there was a history of FS or epilepsy in the family. The risk of epilepsy was 11.6% in the smaller group and 3.0% in the larger group (p < 0.05), but it increased in the smaller group if the first FS or relapses were complex. CONCLUSIONS: The age at the first FS is a substantial factor in the natural history of this nosological entity, since it conditions certain epidemiological characteristics and, especially, the prognosis of these patients.

[The validity of the criteria used to diagnose migraine in the paediatric age]. / Validez de los criterios diagnósticos de migraña en la edad pediátrica.

INTRODUCTION: The diagnosis of migraine is based entirely on clinical data, and generally accepted and valid criteria should be applied as a common diagnostic reference. AIMS: The aim of this work was to study the epidemiological and clinical characteristics of migraine in the paediatric age and to analyse the validity of the criteria used in its diagnosis. PATIENTS AND METHODS: A total of 290 histories of patients with recurring headaches (150 with migraine and 140 with non-migraine headaches) were reviewed, epidemiological and clinical data were collected, and complementary examinations were performed, when necessary. The sensitivity, specificity and likelihood ratio of the Vahlsquit, Prensky and IHS criteria for migraine were all calculated. RESULTS: 32% of cases were migraines with aura. The age of onset of migraine was 8.7 +/- 2.9 years, with no differences between sexes. Nevertheless, in migraine with aura the age of onset (9.8 +/- 3.3 years) and prevalence of females (63.3%) were significantly higher (p < 0.05). Family history was positive in 77.3% of the cases. In migraine, the pain was unilateral (44.4%) or bilateral (55.6%), throbbing (93.7%), interrupted daily activities (63.2%), got worse on doing exercise (68.1%) and was accompanied by nausea (70.1%) and sensitivity to light and sound (66.2%). The throbbing quality, vomiting, one-sidedness and moderate to severe intensity were the items that displayed the greatest discriminating capacity and the IHS criteria were those with the highest diagnostic validity. Diagnosis was not altered by the complementary examinations. CONCLUSIONS: Migraine is a common pathology among children in the paediatric age and generally begins in the school age. The IHS criteria allow it to be diagnosed, although monitoring its progress would be the reference test with which to validate the diagnostic criteria.